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RC31 3.N48  B86       The  cost  oi  tubercul 


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Buffalo,  Departaieiit  of  Health 


The  cost  of  tuberculosis  to  the 
county  of  Erie, 


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intl)f(£itPof3'Irttig(jrk 

COLLEGE  OF 

PHYSICIANS  AND  SURGEONS 

UBRARY 


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http://www.archive.org/details/costoftuberculosOObuff 


College  of  Physicijuis  and  ^>ucg♦qf»»^ 
LiJbcMT 


The  Cost  of 
Tuberculosis 

to  the 
County  of  Erie 


PUBLISHED   BY 

DEPARTMENT   OF  HEALTH, 

BUFFALO,  N.  Y. 


FRANCIS  E.  FRONCZAK,  M.  D., 

Health  Commissioner. 


^'  ;  :,    nil  ^ 

^1  e  2.  I  3  ■  f^"^^' 

The    Co^  of   Tuberculosis 
to  the   County  of  Erie. 

(A  study  based  upon  the  conclusions  of  Ifn  in^  Fisher, 
Chairman  of  the  Committee  of  One  Hun- 
dred on  National  Health.) 


I.    THE  COST  IN  LIVES. 

In  the  year  1909,  the  deaths  in  Erie  County 
from  tuberculosis  were  in  excess  of  seven  hundred ; 
from  pulmonary  tuberculosis,  there  were  632 
deaths;  from  all  other  forms  of  tuberculosis,  about 
120;  making  in  all  752  deaths  as  the  harvest  from 
this  disease  in  one  year. 

(Figures  on  pulmonary  tuberculosis  from  the 
State  Department  of  Health. — Non-pulmonary 
deaths  are  an  estimate  based  upon  usual  percent- 
age found,  as  State  Department  of  Health  had  no 
classified  figures  on  non-pulmonary  forms  for  Erie 
County  only.) 

There  is  much  reason  for  believing  that  a  large 
number  of  deaths  recorded  as  pneumonia,  etc.,  are 
due  to  tuberculosis. 

The  depleting  influence  of  tuberculosis  can  be 
discerned  in  the  fact  that,  unlike  other  diseases, 
it  takes  its  victims  at  their  most  productive  and 
p-»Cot  hopeful  time  of  life.  Then,  again,  to  quote 
Prof.  Fisher,  "Deaths  from  tuberculosis  among 
such  classes  as  are  chiefly  a  burden — paupers, 
criminals  and  defective  classes  in  penal  institu- 
tions, refoiTnatories  and  poor  houses — is  ex- 
tremely small."  In  short,  not  only  does  the  largest 
percentage  of  these  deaths  come  in  the  productive 
years  of  life,  but  among  the  industrious,  the  most 
self-sacrificing  and  self-respecting  citizens  of  the 
community.  Tuberculosis  takes  those  who  are 
the  most  worthy  and  not  the  vicious.  The  least 
useful  do  not  suffer  so  much  as  those  whom  every 

2 


community  would  be  ^lad  to  preserve  and  keep 
with  them.  A  well-known  writer  says:  '^Con- 
sumption  is  the  most  certain  of  the  afflictions  of 
the  poor.  It  is  tuberculosis  that  keeps  the  lives  of 
the  poor,  like  their  annals,  short." 

In  the  report  of  the  Committee  of  One  Hundred 
on  National  Health,  prepared  by  the  National  Con- 
servation Commission,  Professor  Irving  Fisher, 
the  Chairman  of  that  Committee,  asserted  that  from 
the  most  conservative  point  of  view  75  per  cent,  of 
the  deaths  from  tuberculosis  could  be  prevented. 
Many  others  assert  that  90  per  cent,  of  the  cost  of 
tuberculosis  can  be  prevented. 

Professor  Fisher,  considering  that  the  deaths 
occur  in  the  earlier  years  of  life,  concludes  that  the 
eradication  of  tuberculosis  would  save  on  an  aver- 
age at  least  twenty-Tour  years  for  each  person  who 
now  falls  victim.  This  is  making  what  appears  to 
be  a  very  generous  allowance  for  the  fact  that  the 
lives  saved  are  weak. 

Allowing  for  the  proportion  of  the  years  now 
devoted  to  productive  labor,  Professor  Fisher  con- 
cludes further,  '  *  That  the  working  period  lost  by 
death  is  at  least  seventeen  years  for  each  dying- 
consumptive;"  but  assuming  we  could  extend  the 
lives  of  those  now  dying  of  tuberculosis  fifteen 
years,  what  an  enormous  gain  would  result ! 

11.    COST  IN  DISABILITY. 

Dr.  Marshall  L.  Price  of  Baltimore,  now  Secre- 
tary of  the  State  Board  of  Health,  in  the  intensive 
"Study  of  the  Economic  Course  of  Consumption 
in  Wage-Earners,"  says  that  deaths  among  several 
hundred  workers  in  Maryland  were  preceded  by  an 
average  period  of  one  year  and  six  months  of  total 
disability,  following  a  previous  period  of  one  year 
and  seven  months  of  partial  disability,  during 
which  the  workmaai  was  able  to  earn  about  half 
wages. 

3 


Dr.  Fibber  conc'ludcs  that  the  estimate  of  three 
years  and  oue  month  made  by  Dr.  Price  is  ex- 
tremely conservative,  and  could,  without  exagger- 
ation, be  said  to  be  four  years  of  disability. 

III.     COST  IN  UNHAPPINESS. 

In  addition  to  the  cost  of  lives  and  disability, 
there  is  to  be  considered  the  cost  in  disappoint- 
ment and  uuhappiness,  not  alone  of  the  consump- 
tive, but  of  his  family  and  friends — the  cost  of 
human  misery.  Who  can  measure  the  fathomless 
cost  due  to  this  cause?  While  it  cannot  be  meas- 
ured in  terms  of  money,  it  is  surely  a  cost  that 
ought  to  be  the  concern  of  every  human  being 
whose  heart  beats  in  sympathy  with  the  suffering. 

IV.    COST  IN  MONEY. 

Following  a  long  discussion  of  this  phase  of  the 
subject,  Dr.  Fisher  concludes  that  the  most  conser- 
vative estimate  that  can  be  placed  upon  the 
economic  loss  of  the  community  from  the  death 
of  each  consumptive  is  $8,000.00.  Some  authori- 
ties place  it  higher,  some  lower,  but  to  fall  well 
within  safe  figTires,  let  us  take  the  extremely 
cautious  estimate  of  $5,000.00. 

The  deaths  in  Erie  County  in  1909  from  tuber- 
culosis in  all  its  phases  were  over  750,  but  for  the 
sake  of  easier  computation  we  will  take  750  in 
round  numbers.  Taking  the  conservative  figure 
of  $5,000.00,  although  some  say  it  might  well  be 
calculated,  by  considering  all  the  items  involved, 
as  high  as  $11,500.00,  we  find  that  the  annual  waste 
to  the  County  in  the  economic  loss  is  $3,750,000.00. 

In  a  period  of  ten  years,  which  is  a  very  short 
time  in  the  life  of  an  institution  like  a  hospital, 
this  loss  will  amount  up  to  the  stupendous  sum 
of  $37,500,000.00.     If  the  yearly  death  rate  were 


reduced  ton  per  cent.,  there  would  be  a  saving  to 
the  County  of  $;j,750,000.00  in  ten  years.  If  twenty 
per  cent.,  the  saving  would  Ix;  $7,500,000.00.  If 
twenty-five  per  cent.,  there  would  be  a  saving  in  ten 
years  of  $11,250,000.00,  and  if  of  forty  per  cent., 
there  would  be  a  saving  of  $15,000,000.00;  and  if 
the  death  rate  could  be  decreased  seventy-five  per 
cent.,  which  Dr.  Fisher  concluded  would  be  a  con- 
servative estimate  as  to  the  preventable  deaths 
from  this  disease,  the  saving  to  the  County  would 
be  $28,125,000.00  in  ten  years,  or  $2,812,500  every 
year. 

These  figures  are  not  fanciful,  but  the  conclu- 
sions of  a  hard-headed,  practical  student  whose 
every-day  work  makes  him  familiar  with  the  sub- 
ject he  discusses.  These  conclusions  are  based 
upon  the  capitalized  value  of  the  economic  loss  due 
to  the  early  death  of  a  life  whicb  by  preventable 
measures  could  be  prolonged. 


LOSS  TO  THE  CONSUMPTIVE. 

Dr.  Fisher  further  divides  his  economic  loss  by 
reason  of  the  death  of  each  consumptive  into  two 
parts. 

First,  into  the  loss  to  the  consumptive  himself, 
60  per  cent. ;  and 

Second,  into  the  loss  to  others  than  the  con- 
sumptive by  reason  of  his  death,  40  per  cent. 

First,  in  relation  to  the  consumptive,  taking  our 
750  as  the  number  of  deaths  in  the  County  every 
year,  and  60  per  cent,  of  $5,000.00  or  $3,000.00  as 
the  loss  to  the  indi^ddual  himself,  we  find  that  the 
yearly  loss  to  the  consumptives  themselves  is 
$2,250,000.00,  or,  for  a  period  of  ten  years,  $22,- 
500,000.00. 

Decreasing  the  death  rate  10  per  cent.,  then, 
would  amount  to  a  saving  of  $2,250,000.00  for  a 
period  of  ten  years. 


Deoreasiug  the  death  rate  20  per  cent,  would 
amoimt  to  a  saving  to  the  eonsunii)tives  themselves 
of  ^"30,000.00  nnimally,  or  $4,500,000.00  lor  a 
period  of  ten  years. 

Decreasing  the  annual  death  rate  25  per  cent, 
would  amount  to  a  saving  to  the  eonsmnptives 
themselves  of  $562,500.00  annually,  or  $5,625,000.00 
in  ten  years. 

Decreasing  the  death  rate  40  per  cent,  would 
amount  to  a  saving  to  the  consumptives  them- 
selves of  $900,000.00  yearly,  or  $9,000,000.00  in  ten 
years. 

Decreasing  the  death  rate  75  per  cent.,  the  con- 
servative estimate  which  Professor  Fisher  says  is 
the  percentage  of  preventable  deaths  from  this 
cause,  the  saving  to  the  consumj^tives  themselves 
would  be  $1,687,500.00  yearly,  or  $16,875,000.00  for 
a  period  of  ten  years. 

Taking  the  death  rate  again  of  750  for  the 
County,  and  $2,000.00  which,  on  the  basis  of  our 
calculation,  is  the  loss  to  others  than  the  consump- 
tive by  reason  of  his  death,  we  find  that : 

The  yearly  loss  to  others  than  the  consumptive 
himself  is  $1,500,000.00,  or  $15,000,000.00  for  a 
period  of  ten  years. 

LOSS  TO  OTHERS  THAN  THE 
CONSUMPTIVE. 

Decreasing  the  death  rate  10  per  cent,  would 
save  to  others  than  the  consumptive  $150,000.00 
yearly,  or  $1,500,000.00  for  a  period  of  ten  years. 

Decreasing  the  death  rate  20  per  cent,  would  be 
a  saving  to  others  than  the  consumptive  of  $300,- 
000.00  annually,  and  for  a  period  of  ten  years 
$3,000,000.00. 

Decreasing  the  death  rate  40  per  cent,  would 
amount  to  a  saving  to  others  than  the  consumptive 
of  $600,000.00  yearly,  or  for  a  period  of  ten  years 
of  $6,000,000.00. 

6 


Decreasing  tlie  deaths  from  tliis  disease  75  per 
cent.,  the  conservative  estimate  of  Dr.  Fisher, 
would  amount  to  a  saving  of  $1 ,1 25,000.00  yearly  to 
others  than  the  consumptive,  and  to  $11,250,000.00 
for  a  period  of  ten  years. 

In  estimating  these  deaths  to  have  the  economic 
value  of  $5,000.00,  the  non-workers  have  been 
included,  the  man's  wife  and  dependent  members 
of  his  family  as  having  to  him  and  to  the  commun- 
ity an  economic  value,  as  Professor  Fisher  says, 
*'The  man  who  spends  a  great  deal  on  his  family 
does  so  because  they  are  so  precious  to  him,  and 
this  expenditure,  while  a  cost,  is  mostly  significant 
as  indicating  that  he  conceives  a  sentimental 
value  which  is  high,  though  impossible  to  express 
in  figures."  But  if  all  those  who  are  not  wage- 
earners  were  eliminated,  the  net  cost  would  be 
reduced  only  one-half.  Even  if  we  do  this,  assum- 
ing that  the  man's  wife,  sons  and  daughters  have 
no  economic  value,  we  would  still  have  enormous 
economic  waste,  to  say  nothing  of  the  irreparable 
waste  of  human  life. 

LOSS  TO  THE  CHILDREN. 

The  most  pathetic  thing  about  the  unnecessary 
deaths  from  tuberculosis  is  the  fact  that  it 
deprives  the  children  of  almost  everything  that 
makes  for  their  future.  Deprived  of  their  father 
and  the  economic  advantages  that  come  from  his 
earning  power,  to  refer  to  the  economic  factors 
only,  the  child's  physical  development  is  stunted, 
his  educational  advantages  sadly  curtailed,  and  if 
he  survives  he  is  thrown  on  the  world  half  edu- 
cated and  at  a  great  disadvantage  with  his  fellows 
in  his  struggle  for  a  livelihood.  An  investigation 
recently  made  in  Troy,  N.  Y.,  showed  that  52  per 
cent,  of  the  inmates  of  the  orphan's  homes  there 
were  orphaned  by  reason  of  the  death  of  either  one 
or  both  the  parents  from  tuberculosis. 


SAVE  THIS  WASTE  OF  LIVES 
AND  MONEY. 

To  make  the  iiglit  against  tuberculosis  will,  of 
course,  cost  money,  but,  as  Professor  Fisher  says, 
*'The  light  against  tuberculosis  is  bound  to  be 
costly,  and  consists,  in  fact,  of  substituting  money 
cost  invested  in  hospitals,  attendants,  and  educa- 
tion for  the  far  greater  cost  now  incurred  from 
death  and  invalidism." 

All  authorities  agree,  as  stated  by  one  of  their 
number,  that  "from  an  economic  point  of  view,  the 
investment  in  isolation  hospitals  for  incurables  is 
at  present  j^robably  the  most  profitable  method  of 
spending  money  for  reducing  the  cost  of  tuber- 
culosis." 

**That  tuberculosis  may  be  practically  eradi- 
cated is  evidenced  by  the  fact  that  the  mortality 
varies  so  greatly  in  different  commimities,  and  is 
declining  in  almost  all." 

Probably  the  most  striking  paper  of  all  those 
read  at  the  International  Conference  on  Tubercu- 
losis was  the  one  by  Newsholme  of  England,  in 
wfiicli  he  showed  from  an  examination  of  the  mor- 
tality records  of  Europe  and  America,  that  the 
decline  in  the  death  rate  from  tuberculosis  had 
been  exactly  proportionate  to  the  number  of 
hospital  beds  provided. 

Hospitals  for  incipients, — for  the  early  cases, — 
to  cure  those  whom  it  is  possible  to  cure.  Hospi- 
tals for  the  advanced,  to  make  their  declining  days 
easier,  and  to  save  the  rest  of  the  community  from 
infection  are  the  two  great  needs. 

Dr.  Morris  LetuUe  truly  says,  "The  consump- 
tive is  made,  not  born."  In  our  modern  congested 
life  in  industry  and  housing;  in  our  failure  to 
properly  protect  the  well,  we  have  made  the  con- 
sumptive. AVill  we  do  what  we  can  to  stop  the 
spread  of  this  disease  and  undo  the  evil  we  have 
done  ? 

8 


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'-^he   cost  of  ;,v     ^'^^^*^- 
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